Urology Coding Alert

How well can you answer these common questions?

We gave you three scenarios related to adrenalectomy coding as a self-check. Here are the questions again, along with the correct answers.

Question 1:  According to CPT^®, you should report 60545 when the surgeon (via an open approach) excises a retroperitoneal mass in addition to the adrenalectomy. If the urologist uses a laparoscopic approach, does the work of 60650 cover both the excision of the retroperitoneal mass and the adrenalectomy?

Answer  1: Code 60650 (Laparoscopy, surgical, with adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal) does not include the removal of an associated retroperitoneal mass as does 60545 (Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal [separate procedure]; with excision of adjacent retroperitoneal tumor) does.

Option A: To indicate the extra work associated with excision of a contiguous retroperitoneal mass, consider adding modifier 22 (Increased procedural service)  to code 60650. The urologist needs to clearly document the extra work and time spent on the removal.

Option  B:  You can instead consider adding the unlisted codes 49329 (Unlisted laparoscopy procedure, abdomen, peritoneum and omentum) or 60659 (Unlisted laparoscopy procedure, endocrine system) to your 60650 claim to describe the extra dissection and surgical work performed. Again, the urologist will need to provide detailed documentation.

Question 2: The surgeon performs a left adrenalectomy and partial upper pole nephrectomy on a patient whose adrenal cancer was invading the upper pole of his left kidney. Adrenalectomy is bundled into a radical nephrectomy. How do you report this pathological scenario in conjunction with a partial nephrectomy?

Answer 2: CCI (Correct Coding Initiative) edits bundle the two procedures. Code 50240 (Nephrectomy, partial) includes 60540 (Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal [separate procedure]). For this operative session, submit only 50240 for both procedures.

Question 3: The surgeon completes a laparoscopic adrenalectomy and resection of peritoneal and omental tumor implants during the same session. What codes do you include on the claim?

Answer 3: Yes, you can submit a separate code for the resection of the peritoneal and omental tumor implants. Submit 49329 for that portion of the surgery and 60650 for the laparoscopic adrenalectomy.

Because 49329 is an "unlisted" code, be sure to include thorough documentation of your surgeon's work supporting the code.